Maternal-Newborn and Paediatric Nursing · Chapter 2
The Three Shunts and the First Action
The placenta and the fetal circulation keep a pregnancy alive; three emergencies end it in minutes. Watch the shunts close breath by breath and dose the drug that holds one of them open, then run cord prolapse, magnesium sulfate toxicity and early postpartum haemorrhage in order. In each of the three, the first action is the whole answer — lift the presenting part, stop the infusion, massage the fundus.
Take the shift
A ductal-dependent lesion deteriorates as the duct closes. Prostaglandin E1 holds it open at 0.05 to 0.1 micrograms per kilogram per minute — the arithmetic appears on the right.
The cord, in one line
Two arteries and one vein in Wharton jelly. The single vein carries oxygenated blood to the fetus; the two arteries carry deoxygenated blood away to the placenta. A two-vessel cord occurs in about one percent of births and obliges careful newborn assessment, often with a renal ultrasound.
Room 4 · para 1 · 38 weeksBradycardia
Spontaneous rupture of membranes at 0412 with the vertex at station minus 2 on oxytocin augmentation. The tracing drops to 70 and stays there. You feel a pulsating cord in the vagina.
Click the actions in the order you would perform them. The list is deliberately not in order, and four of the items are things nurses actually do that make this worse.
Steps in order0 / 6
Thirty minutes after a vaginal birthBleeding
Steady bright red loss, the pad is soaked, the fundus is boggy and above the umbilicus and deviated to the right. Estimated cumulative loss so far is over 1000 mL.
Click the actions in order. Two of the drugs in this list are contraindicated in one of the three patients above — switch the patient and watch which one becomes dangerous.
Steps in order0 / 6
In uteroLungs fluid-filled, placenta doing the work